Katya Samardina

Setting the World on FHIR®: Three Reasons Why This Hot New Standard is Sparking Action


In mid-June, HIMSS issued a press release announcing the renewal of a “cooperation agreement to advance the goal of interoperability of health information” between two long-standing initiatives: Health Level Seven International® (HL7®) and Integrating the Healthcare Enterprise (IHE).  The press release described how “the joint statement of understanding provides for improved communication and coordination of schedules and projects to help expedite the development and adoption of the HL7® Fast Healthcare Interoperability Resources (FHIR®) standard.”

So what is it about FHIR® that’s inspiring HL7® and IHE to explicitly ratify their commitment to realizing and implementing the standard as soon as humanly possible?

I can think of three important items: implementer focus, ease of use, and community.

Let’s take a quick look at each and consider how they contribute to FHIR®’s main value proposition.

  1. Implementer focus 
    FHIR® is laser-focused on the implementer. It aims to support current, real-world use, i.e., what its implementer’s systems are currently doing, rather than what FHIR®’s developers think they should be doing.
    For example, with FHIR®, a property is added to the core contents of a resource only if it’s supported by the majority of existing systems (sometimes called “the 80 percent rule”), while any additional properties are then implemented using extensions. Because of the standard’s ability to safely extend resources to meet specific use cases through the extension-discovery and profiling mechanisms, FHIR® keeps the resource’s size and complexity to a minimum, making it easier for an implementer to understand and use it. 
    Additionally, by holding events like Connectathons—where implementers test the developing standard and provide feedback—and by providing open-source libraries and internet-available test servers, FHIR®’s developers make a pointed commitment to involving both new and veteran implementers in its development.
  2. Ease of use 
    For a new implementer looking to become proficient with healthcare standards, healthcare interoperability is a complicated concept with a steep learning curve, since much of the language and tooling it uses is specific to the healthcare domain.
    However, FHIR® leverages standards and tooling that are used outside of the healthcare domain, which means that new FHIR® implementers can build on existing skills instead of needing to develop entirely new, healthcare-specific skills. Because of this, it’s not uncommon for new implementers to be productive within days of using FHIR®, rather than weeks or months. 
    Additionally, by providing a simple and discoverable extensibility mechanism plus core resources, implementers can start small, yet have the confidence that FHIR® will accommodate their needs as they grow.
  3. Community
    Since its inception, FHIR® has been developed by a community that leverages instant messaging, list servers, blogs, and the open nature of the internet itself to make the standard freely available to anyone who wishes to view or contribute to it. This community enthusiastically welcomes comments by providing links on every page, and these comments are managed within an openly available source control system.
    This open-community spirit has prompted other standards-developing organizations to add their expertise to FHIR®’s development, including openEHRCIMI, and the SMART project. This, in turn, has inspired further initiatives such as the Argonaut Project, a vendor-sponsored initiative that aims to bring “open standards to the arcane world of healthcare interoperability,” assist in the development of FHIR®, and facilitate its alignment with CCDA and security protocols like OAuth2 and OpenID Connect. 

I believe these three main items make the value proposition of FHIR® very clear. It’s: 

  • Quick to implement. With familiar tools, libraries freely available to developers, and rapid vendor adoption across the industry, FHIR® will make it easier to move data between systems and eliminate the restriction of being able to implement only those systems that can talk to proprietary interfaces.
  • Cost-effective to implement. While healthcare interoperability will likely never be cheap or easy, FHIR® removes many common cost barriers.
  • Device and mobile friendly. FHIR® supports the development of mobile and internet-of-things technologies by offering a common standard for representing and moving data.
  • Flexible. Implementers can rapidly adopt, test, and even change solutions as requirements evolve.
  • Free of vendor lock-in, since it doesn’t need proprietary interfaces. This offers more choices to consumers while encouraging vendors to innovate on features and functionality.
  • Adopted incrementally. The considerable work invested in aligning FHIR® with existing standards means implementing the standard won’t require a “rip and replace” approach. Instead, an organization can implement it gradually, and vendors can assist that journey by offering supporting products like integration engines.
  • Characterized by a straightforward migration process, as it capitalizes on the valuable experience the community gained using HL7®’s Version 2, Version 3, and CDA product lines.

By involving implementers from the start, issues that could’ve impeded FHIR®’s uptake have been recognized and corrected early in the development process, which has instead bolstered FHIR®’s uptake and helped implementers see that their needs are being heard loud and clear by the standards community.

So it shouldn’t really come as a surprise that HL7® and IHE are so eager to renew their FHIR® vows. The two initiatives are all too aware of the significant benefits FHIR® will bring to developers, implementers, IT leaders, and the entire healthcare community at large, and they are unwilling to risk watching it languish on the drawing board for too long, losing momentum due to any perceived lack of enthusiasm, and delaying the countless benefits the standard will soon realize for patients everywhere.

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